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Sunday, September 16, 2012

Superbug kills 7th person at Md. NIH hospital

World Hot Topics Blog

NIH superbug claims 7th victim

A deadly, drug-resistant superbug
outbreak that began last summer at the National Institutes of Health Clinical
Center claimed its seventh victim Sept. 7, when a seriously ill boy from
Minnesota succumbed to a bloodstream infection, officials said Friday.

The boy was the 19th patient at the
research hospital to contract an antibiotic-resistant strain of the bacterium Klebsiella
pneumoniae that arrived in August 2011 with a New York woman who needed a
lung transplant. But his case marked the first new infection of this superbug
at NIH since January — a worrisome signal that the bug persists inside the huge
brick-and-glass federal facility in Bethesda.

“It’s heartbreaking,” said John Gallin, the
physician-researcher who directs the clinical center. “What happened this
summer was a very unfortunate case. All of these cases are hugely sad cases.”

The boy arrived in Bethesda in April
after complications arose from a bone marrow transplant he received last year.
His underlying condition — a severe genetic defect that crippled his immune
system — increased his risk of acquiring the superbug, as did the steroids and
other drugs the boy was given to combat complications from the transplant.

“We worried he was set up for a bad
infection,” said Gallin.

On July 25, routine rectal swabs of
patients for hospital-borne infections — a measure put in place during the
worst of the outbreak last fall — detected the superbug in the boy.

Genetic analysis showed the boy’s
strain matched that of the superbug that arrived last year. It eventually
spread to 17 additional patients, of whom 11 died. Six of those deaths were
directly attributed to the superbug by NIH staff. The NIH did not make the
outbreak public until describing it in a scientific publication last month.

As the superbug spread last fall,
NIH staff members built a wall to isolate infected patients, ripped out
plumbing that harbored the bacteria, hired monitors to ensure doctors and
nurses were properly scrubbing their hands and even blasted patients’ rooms
with vaporized disinfectant.

By January, those measures had
apparently halted the spread. For six months, no new patients became infected.

But in July, the boy tested positive
for the superbug. Clinic staffers isolated him in the intensive-care unit and
raced to treat the infection.

The boy’s superbug originally
appeared vulnerable to one antibiotic, but after a week of therapy, the
infection grew impervious to that drug, too, Gallin said. The NIH obtained an
experimental antibiotic, but it also failed.

“This kid probably got this
infection because a patient who was a carrier [of the superbug] was on the same
unit,” said Gallin. “There was undoubtedly some intrahospital transmission
despite our best efforts.”

Swabs picked up the superbug on a
railing outside the boy’s room, but Gallin said it’s impossible to know whether
the boy or someone else deposited it there.

Gallin said that earlier this year,
two other patients arrived at the clinical center carrying different strains of
potentially deadly drug-resistant Klebsiella. Neither of those strains has
spread to other patients, Gallin said. One of those two patients was treated at
two hospitals in Maryland before transferring to NIH.

Gallin declined to name those
hospitals and, citing medical confidentiality, also declined to provide details
about the boy, such as his age.

The NIH clinical center is a federal
facility that is not required to report hospital-borne infections to the state.
Nor does it have to report this type of infection to the federal Centers for
Disease Control and Prevention, although Gallin said the CDC has been working
closely with NIH to help control the outbreak.

Montgomery County health officials
were not aware of the death, a county health department spokeswoman said,
although Gallin said the NIH had also informed the county of the death.

Klebsiella infections are a major
problem for severely ill hospitalized people whose immune systems are weakened.
Experts, including Gallin, are quick to reassure the public that such
hospital-borne infections pose no risk to healthy people outside hospitals.

In 2011, about 80 percent of
Maryland’s acute-care hospitals had at least one patient with
carbapenem-resistant bacterial infection — the larger class of infections to
which resistant Klebsiella belongs — Henry said in an e-mail.

Nationwide, about 6 percent of
hospitals are battling outbreaks of this class of superbugs, according to the
CDC, which has stepped up nationwide surveillance. Strains similar to those
seen at NIH have spread across the world since first appearing in North
Carolina in 2001, Gallin said.

Maryland said it is working with
hospitals, nursing homes and other organizations to control and prevent
infections through good hand hygiene, screening of patients for bacteria, room
cleaning, and the judicious use of antibiotics.

At Suburban Hospital in Bethesda,
which is near the NIH clinical center, hospital officials said they have had no
outbreaks of drug-resistant Klebsiella. Only once or twice in the past year has
there been evidence of such an infection, said Rita Smith, manager of the
hospital’s infection control efforts.

The most common drug-resistant
infections at Suburban, part of the Johns Hopkins health system, include
methicillin-resistant Staphylococcus aureus, or MRSA, E. coli, and
Clostridium difficile.